Noninvasive monitoring of cerebral oxygenation in preterm infants: preliminary observations.
Noninvasive monitoring of cerebral oxygenation in preterm infants: preliminary observations.
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早产儿脑氧合的无创监测：初步观察。
DOI：
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发表时间：
1985
期刊：
影响因子：
8
通讯作者：
Frans F. Jöbsis vander Vliet
中科院分区：
文献类型：
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作者：
J. Brazy;D. Lewis;M. H. Mitnick;Frans F. Jöbsis vander Vliet
探讨了一种用于小早产儿床边监测脑氧合的无创光学方法。通过对近红外光的差分吸收，在经照射的大脑前野观察细胞色素aa3氧化还原水平、血红蛋白氧合状态和组织血容量的变化。总体而言，脑氧合血红蛋白与经皮氧相关，r = 0.44 p < 0.0001；然而，在没有心肺疾病的情况下，相关性最好。伴或不伴心动过缓的缺氧导致血红蛋白脱氧和细胞色素aa3转移到更低的状态。当缺氧发作连续发生或持续时间较长时，aa3降低与血红蛋白脱氧同时发生，但其恢复到基线值有时滞后于血红蛋白氧合的恢复。在一名大动脉导管未闭的婴儿中，即使是短暂的轻度心动过缓发作也会导致细胞色素aa3急剧降低，然后才转变为更大的血红蛋白脱氧。导管结扎后这种反应消失。一般来说，脑氧合的前期状态、缺氧的严重程度和持续时间以及循环异常的存在与否都会影响aa3对缺氧的反应。连续无创近红外监测脑氧合可以在床边对生病的早产儿进行。
A noninvasive optical method for bedside monitoring of cerebral oxygenation in small preterm infants was evaluated. Through differential absorbance of near infrared light, changes in the oxidation-reduction level of cytochrome aa3, in the oxygenation state of hemoglobin and in tissue blood volume were assessed in the transilluminated anterior cerebral field. Overall, cerebral oxygenated hemoglobin correlated significantly with transcutaneous oxygen, r = .44 p less than .0001; however, correlation was best in the absence of cardiorespiratory disease. Hypoxia with or without bradycardia led to hemoglobin deoxygenation and a shift in cytochrome aa3 to a more reduced state. When hypoxic episodes came in series or were prolonged, aa3 reduction occurred simultaneous with hemoglobin deoxygenation but its recovery to base-line values sometimes lagged behind the return of hemoglobin oxygenation. In one infant with a large patent ductus arteriosus, even brief episodes of mild bradycardia caused precipitous reduction of cytochrome aa3 before any shift to greater hemoglobin deoxygenation. This response disappeared after ductal ligation. In general, the antecedent state of cerebral oxygenation, the severity and duration of deoxygenation, and the presence or absence of circulatory abnormalities all influenced the aa3 response to hypoxia. Continuous noninvasive near infrared monitoring of cerebral oxygenation can be performed on sick preterm infants at the bedside.